Ontario to exclude high-strength opioids from public drug formulary

Sara Tatelman | July 26, 2016

Ontario is excluding certain higher-strength, long-acting opioids from the formulary for the Ontario Drug Benefit program, the Ministry for Health and Long-Term Care said in a notice to physicians on its website.

“The inappropriate use, abuse, and diversion of prescription narcotics has emerged as a significant public health and safety issue in Canada and other jurisdictions around the world,” the notice said.

Beginning in January 2017, the province will no longer cover morphine in 200-milligram tablets, hydromorphone in 24- and 30-milligram capsules, fentanyl patches that deliver between 75 and 100 milligrams of the drug per hour and meperidine in 50-milligram doses.

So with the province taking action on its formulary, what issues do the changes raise for the plan sponsors of private benefits plans?

“The vast majority of [employer-sponsored] plans in the country are open formulary, meaning everything and anything gets added,” says Helen Stevenson, president and chief executive officer of the Reformulary Group in Toronto.

She notes that while employers don’t often get involved in the specifics of their formularies, they should ask their plan administrators how they monitor opioid use among their staff and what steps they take if any red flags appear.

“The employer does need to be one step removed, because they can’t know who’s taking which drug, but they can ask the questions of their plan administrator, for sure,” says Stevenson. “[They can] look at whether they can be excluding some of these drugs from their formularies as well.”

The changes by the Ontario government have sparked some criticism, including from palliative care doctors who have said they’ll make it more difficult to provide pain relief to patients near the end of their life, the Globe and Mail reported yesterday.